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Symbolic Solidarity or Virtue Signaling? A Critical Discourse Analysis of the Public Statements Released by Academic Medical Organizations in the Wake of the Killing of George Floyd

Brown, Allison PhD1; Auguste, Emmanuelle2; Omobhude, Favour3; Bakana, Naomie4; Sukhera, Javeed MD, PhD5

Author Information
doi: 10.1097/ACM.0000000000004597

Abstract

On May 25, 2020, George Floyd, an unarmed 46-year-old Black man, was killed after a white police officer pinned him to the ground and knelt on his neck for 9 minutes and 29 seconds. The video footage of Floyd’s horrifying death went viral and sparked powerful protests for racial justice. These events reignited support for the Black Lives Matter (BLM) movement, which has drawn attention to the systematic dehumanization and devaluation of Black lives since 2013.

The murder of George Floyd inspired a moment of reflection in the academic medicine community, where there is a long-standing history of anti-Black racism, exemplified by the deliberate exclusion of Black students from medical school and Black physicians from membership in the American Medical Association (AMA). 1,2 Policies and structures that disproportionately disadvantage Black learners and faculty remain entrenched in academic medical organizations, yet there is an increasing awareness of how systemic racism in academic medicine produces and exacerbates inequities in patient care. 3–11 Like many institutions that wield societal power, academic medical organizations have largely shied away from critical dialogue about racism, including from openly condemning police brutality and supporting the BLM movement during numerous prior incidents that have permeated mainstream media. 12–14

Shortly after Floyd’s murder, academic medical organizations in the United States (U.S.) and Canada swiftly released public statements condemning racism and expressing solidarity with Black communities. Although these statements have drawn considerable interest, 15,16 little research has explored this discourse and its implications for efforts to address anti-Black racism. The language used by academic medical organizations plays a fundamental role in shaping systems, structures, and practices and thus is often a focus of scholarship. 17–19 Discourse can reproduce the status quo, or it can transform it. Public discourse in response to these events provides critical insight into how organizations may be conceptualizing social problems; reflecting on anti-Black racism and racial violence; and, most importantly, committing to action in institutional and disciplinary contexts. Our study sought to critically examine the initial statements published by a sample of medical schools and academic medical organizations in the aftermath of George Floyd’s murder.

Method

Critical discourse analysis (CDA) is a qualitative approach to addressing social problems by systematically analyzing language as a social practice; CDA uses an in-depth critique of how language shapes and (re)produces power. 20 A primary objective of CDA is to examine how language reflects social reality by uncovering explicit and implied ideologies in the contexts in which a discourse is situated. 21,22 CDA approaches also seek to critique language while informing social change. We used Fairclough’s CDA framework to examine the initial statements published by a sample of academic medical organizations following the death of George Floyd. 21 Fairclough’s framework has been used previously to analyze language in the context of discursive events, including the BLM movement, aligning it with our chosen methodology and research question. 23–26

Data collection: Assembling the archive of statements

We assembled an archive comprising the initial responses publicly released by a sample of medical schools and academic medical organizations in the U.S. and Canada between May 25 and August 31, 2020. All 17 Canadian medical schools were included in our initial search. Due to the sheer volume of medical schools in the U.S., our initial search used maximum variation sampling strategies to collect a range of responses across schools from a diverse set of geographic regions, demographics, and historical contexts. For example, we searched for responses from U.S. medical schools at historically Black colleges and universities (HBCUs), those with a Black dean, those in cities with widely publicized instances of police brutality, and those with both the highest and lowest proportions of Black medical students based on public data from the Association of American Medical Colleges. 27 We identified statements by searching the institution’s official website and social media posts, which often linked to the original statement on the website. We also included national organizations that play a regulatory role in medical education and membership-based organizations that represent medical learners and practicing physicians.

After conducting our initial search, we met regularly to define, discuss, and finalize the scope of the archive, aiming to have a balance in the volume of statements from medical schools in Canada and the U.S. and representation that would allow for both breadth and depth in our analysis. The final archive included statements from medical schools across all geographic regions of the U.S., including at least 2 statements from medical schools at HBCUs, Ivy League institutions, institutions that receive a substantial amount of public funding, those with a Black dean, those located in cities with high profile police killings of Black people, and those with the highest and lowest proportions of Black medical students. We cross-verified all items to ensure that statements were representative of large academic medical organizations and not from individual departments or units.

Data analysis

Our analysis was informed by Fairclough’s 3-dimensional framework, which includes descriptive, interpretive, and explanatory analyses. 21 Our descriptive analysis examined the linguistic properties of the statements. We conducted linguistic inquiry and word count (LIWC) using LIWC2015 (Pennebaker Conglomerates, Inc., Austin, Texas) to analyze descriptive variables, such as word count, linguistic dimensions, constructs, and summary language variables including analytical thinking, clout, authenticity, and emotional tone (see Appendix 1). 28 We also developed a custom dictionary to analyze the frequency of words and phrases of interest defined by our team a priori. Our dictionary included different terms that could be used to discuss racism and racialization as well as variables of interest such as whether previous victims of police violence were named (see Appendix 1).

Our interpretive analysis focused on identifying dominant discursive strands in the statements; that is, we identified the explicit and implied messages that were conveyed through the production and consumption of the text. We developed a standardized tool for our interpretive analysis that included key questions informed by Fairclough’s framework (see Supplemental Digital Appendix 1 at https://links.lww.com/ACADMED/B226 for the complete tool). For example, we critiqued specific aspects of the statements, such as what was explicitly communicated and what was absent, given that CDA contends that ideologies are often located in what is unsaid. 21 After initial piloting of our tool, we independently analyzed each statement in the archive, with 2 members of the research team analyzing each statement. Data were synthesized for items with categorical response options that could be consolidated (e.g., questions with no/yes response options). We initially conducted our interpretive analysis independent of the findings from the LIWC and then we revisited the LIWC results to examine convergence with the interpretive findings.

Our explanatory analysis built on the results of our descriptive and interpretive analyses; we considered the wider sociocultural, sociohistorical, and sociopolitical conditions that could explain the production and consumption of the statements, including whom they were produced by (discourse producers) and how the ideologies expressed in the discourse mediate power for those the discourse is intended to influence (discourse consumers).

To promote reflexivity, we were conscious of how our unique experiences shaped this research. Our team comprised a range of professional perspectives and lived experiences. Allison Brown is a medical education scholar who examines social issues through critical methods of inquiry and is white and thus has no lived experiences of racism. Emmanuelle Auguste, Favour Omobhude, and Naomie Bakana have lived experiences of anti-Black racism and, at the time of this research, were undergraduate students and aspiring physicians. Javeed Sukhera is a racialized non-Black physician and health professions education researcher. We remained sensitive to how our identities and experiences shaped our analysis as our study evolved. Each statement was analyzed by multiple members of our team to provide a variety of perspectives and critiques. Further, we complemented our interpretive analysis with LIWC and other pertinent indicators to gather evidence that could be used to converge and corroborate our collective critiques.

Ethical review and approval were not required per Canada’s Tri-Council Policy Statement.

Results

Descriptive analysis

Our archive included 45 statements published between May 31 and July 27, 2020, including 24 from the U.S. and 21 from Canada. In total, 35 medical schools and 10 national organizations were represented. Statement length varied from 75 to 855 words. Statements were most often written from a first-person plural point of view and in the past tense. Titles often articulated that the statement was from a senior leader (e.g., “a statement from the Dean”) or on the topic of racism (e.g., “a statement on/against/regarding racism”). Not all of the statements included an image. Of those that did, the most common images were photos of smiling deans, all of whom appeared to us to be visibly white. None of the statements included photos of faculty of color. Images of racially diverse groups of students protesting were included in 2 statements and 1 included a photo of a mural of George Floyd.

The LIWC demonstrated that statements used formal and analytical language and often reflected hierarchical thinking and power differentials between discourse producers and consumers (see Appendix 1). Apart from 1 statement, the language used was considered guarded and distanced based on the authenticity variable. Half of the statements had a negative emotional tone.

The words “racism” and “racist” were absent in almost one-third of the statements, more than half mentioned “systemic racism,” and 5 mentioned “institutional racism” (see Appendix 1). Most did not use the term “anti-Black racism” (35), and only 1 used the term “white supremacy.” One statement did not mention racism whatsoever. Fourteen statements did not refer to racial violence. Nearly half of the statements explicitly mentioned police brutality, with 1 statement mentioning the police and police brutality more than 10 times. Many statements mentioned additional forms of discrimination including sexism, homophobia, and xenophobia. Three statements from Canadian organizations also mentioned anti-Indigenous racism.

Interpretive analysis

Discursive conflict was evident across the statements we analyzed. Several discursive strands appeared to reflect contradictions and tensions between explicit messaging and implied ideologies. 21 First, the death of George Floyd was frequently characterized as a “shocking” recent event. This language suggested that the incident was isolated and perhaps ignored a long-standing history of disproportionate police violence toward Black men and women, including prior instances of violent police killings that were videotaped and disseminated in the media (such as Eric Garner in 2014 and Philando Castile in 2016). Second, statements referenced the institution’s professional values and ethics and took an absolutist position regarding the need to “eliminate” racism, while framing racism as primarily interpersonal and external to the institution, seemingly absolving the organization of structural culpability in maintaining or reinforcing racism. In the few statements that acknowledged systemic or structural racism, discourse drew attention to how racism manifests through curricula, admissions practices, selection processes, and faculty affairs.

Discourse also varied with respect to organizational actions in response to racism. Many statements encouraged readers to self-educate, often providing links to external educational resources about racism and allyship. We identified at least 1 actionable step the organization would take to address racism in approximately one-third of statements. The majority of these strategies focused on individuals, through interventions such as bias training, rather than referencing power or policy change. Many statements contained self-centering strategies to highlight past institutional successes. For example, several statements included links to articles and websites that highlighted the organization’s initiatives related to equity, diversity, and inclusion, such as past awards and achievements. One provided a “nonexhaustive” list of initiatives the institution had undertaken. While these strategies likely were meant to signal a commitment to equity, diversity, and inclusion, nearly all the examples referred to by institutions were not specific to antiracism or anti-Black racism. In addition, few organizations demonstrated humility by acknowledging institutional failures rather than centering prior efforts or intentions.

Another dominant discursive theme was the organizational response of “listening and learning.” This discourse suggested that institutions were not listening or learning before. In addition, very few statements provided a mechanism for feedback. In 7 statements, institutions provided a generic institutional email address to collect feedback, rather than describing a more robust process of meaningful engagement.

In their statements, institutions acknowledged the grief associated with the killing of George Floyd and the ensuing protests by stating it was a difficult time for everyone given the concurrent COVID-19 pandemic. The additional psychological burden and trauma experienced by Black and racialized individuals as a result of these events were acknowledged in some statements, and 6 provided links to mental health resources or supports, nearly all of which were generic wellness services not specific to racialized individuals. Self-care resources for Black, Indigenous, and people of color were embedded in 2 statements.

We identified another discursive conflict with respect to the extent to which institutions expressed their support of and solidarity with the BLM movement. While nearly half of the statements used the term “solidarity,” only 4 explicitly named their support for BLM, one of which was an HBCU, which did so 6 times. Victims of police brutality who were named in statements included George Floyd (30), Breonna Taylor (15), and Ahmaud Arbery (14), as well as other victims of previous incidents (see Appendix 1). Nine statements from Canadian organizations referenced victims of police brutality in the U.S., but only 2 mentioned a victim in Canada, naming Regis Korchinski-Paquet. Thirteen statements did not mention victims or the BLM movement.

Implicit propositions throughout the statements may have constrained how members of the institution felt they could respond to events by emphasizing peace and kindness as the appropriate ideological behaviors at the time rather than protest and activism. One statement referred to the ongoing protests as “riots.” In contrast, a small number of medical schools (mainly HBCUs) openly supported members of their institution taking action to advocate for social change and justice, including offering guidance for how to safely participate in peaceful protest.

Explanatory analysis

Our examination of the sociocultural, sociohistorical, and sociopolitical contexts offered explanations into the current state of race relations, power, and ideologies at these academic medical organizations. Our findings seem to indicate a lack of critical reflection and commitment to institutional accountability to address the legacy of anti-Black racism in academic medicine, including the role that institutions play in perpetuating race-based inequities for Black learners, physicians, and patients. Instead, statements referenced historical events and civil rights activists outside of medicine, including Martin Luther King Jr (6), Nelson Mandela, and the Civil Rights Act, thereby seemingly positioning racism as a past evil rather than as a present and purposeful system of oppression.

The means of discourse production and consumption revealed how ideologies of whiteness dominated institutional hierarchies and exposed colorblind racism, minimizing the unequal treatment, experiences, and outcomes of racialized individuals within the organization. 29,30 The absence of Black voices and perspectives in the statements we analyzed was noticeable, with the exception of 4 statements signed by Black faculty members (2 of which were from HBCUs). This may be due to the lack of racial diversity amongst institutional leadership in academic medicine and thus illuminates how white supremacy prevails throughout many academic medical organizations. The majority of statements were signed by a dean or senior leader (34/45; 9 did not specify an author); that is, they were written by those in positions of power, nearly three-quarters of whom (25/34) appeared to us to be white based on their institutional profile photo.

Most statements also appeared to be directed toward those at lower levels of the institutional hierarchy, denouncing racism as a broad societal issue and professing a superficial commitment to racial justice. For example, rather than committing to changing the systems and structures within the institution, assertive language was often used to convey what individuals within the organization should do instead. Similarly, focusing on broad issues relating to equity, diversity, and inclusion and referencing prior institutional efforts unrelated to racial justice are tactics that have been shown to divert attention away from any institutional responsibility to address anti-Black racism. 31 This aspect of the statements suggests that power and authority can manifest in institutional discourse to not only communicate the ideological behaviors members should abide by but also redirect responsibility away from the institution.

We also identified that the historical and ongoing legacy of anti-Black racism in Canada was ultimately minimized in the statements we analyzed. Anti-Indigenous racism was indeed mentioned in the Canadian discourse, reflecting the historical and present violence resulting from settler colonialism and responses to the Truth and Reconciliation Commission of Canada Calls to Action. 32 While this discourse did make it clear that Canada was not immune to racism, anti-Black racism and police brutality were often omitted. This reflects the tendency in Canada both to minimize the social, cultural, and political practices that perpetuate violence and to portray itself as “not the U.S.” but rather a neutral, peaceful country. 33,34

Finally, we noticed that other identities and systems of oppression were mentioned throughout the discourse perhaps to promote intersectionality. While this may have been a well-intended strategy with the goal of inclusion, it further minimized anti-Black racism in statements released directly in response to anti-Black violence.

Discussion

Our study offers empirical insight into how a sample of academic medical organizations in the U.S. and Canada publicly responded in the aftermath of the killing of George Floyd. While these statements were released in response to demands for widespread accountability for addressing anti-Black racism, we found that institutional discourse distorted and minimized discussions of racism, racial violence, and police brutality; de-emphasized anti-Black racism; and, ultimately, erased and minimized the voices, needs, and concerns of Black communities. The authors of most of the statements in our archive were white faculty members in positions of authority, and the statements used distanced and hierarchical language to broadly condemn racism while rarely calling out or focusing on anti-Black racism. Our findings suggest that such discourses may have externalized the issue of systemic racism, portraying anti-Black racism as outside the institution, and deflected institutional accountability by emphasizing individual action instead of institutional change. 31

Our findings align with the concept of a nonracist discourse, which passively delegitimizes concerns about racism, minimizes the historical legacy of institutional racism, and prioritizes individual behaviors to diminish the culpability and inaction of institutions. 31 While racism indeed manifests through top-down and bottom-up forces and must be addressed at all levels, 35 reinforcing racism as individual actions reframes how others perceive what constitutes racism. Suggesting only that interpersonal racism will not be tolerated ignores the realities and pervasiveness of structural and institutional racism. While nonracist discourse may be perceived as neutral, it reinforces denialism while perpetuating colorblind racism and upholding racial domination and white supremacy. 29,31,36

In contrast, antiracist discourse, which was prevalent in a small number of statements, actively exposes the realities of racism as deeply embedded in systems and structures, upheld and bolstered by institutions. Antiracist discourse communicates a clear intent to dismantle white supremacist ideologies and practices. 31 Although not the norm, examples of antiracist discourse in the statements we analyzed included explicitly outlining next steps for addressing the ways systemic racism has manifested within the organization, such as changing admissions policies and hiring practices. Likewise, these examples used active, antiracist language, as avoiding direct language to discuss racism and downplaying the reality of structural racism are rhetorical and semantic hallmarks of colorblind racism. 29 The self-exculpatory approach of ignoring and minimizing the structural roots and prevalence of anti-Black racism in academic medicine will inhibit meaningful antiracism work by maintaining existing power structures and further marginalizing Black people. 30 Antiracist discourse requires authenticity to promote trust, reciprocity to mitigate power dynamics, responsiveness to enact efficient and effective change, and for voices of color to be centered and affirmed. 25,31

We found a lack of critical introspection in many of the statements we analyzed; this observation was concerning as it may call into question institutional commitment to effectively addressing racism. Our results therefore suggest that casting a critical lens on how organizational structures uphold racial inequities is critical to advancing antiracist praxis. 4,37 Responding to overt forms of racial violence outside of the institution while neglecting to acknowledge and combat the subtle yet systemic racism deeply entrenched within the institution may point to these statements being performative in nature and, ultimately, raise concerns about virtue signaling. Virtue signaling strategies serve to reform or reinforce an organization’s image as progressive, egalitarian, and committed to social welfare, while drawing attention away from injustices that the organization is directly responsible for. Institutional discourse risks being perceived as inauthentic if practices and outcomes do not reflect newly proclaimed values. 38

Our study also highlights the paucity of action-oriented discourse and institutional accountability-taking in the statements we analyzed, as they tended to focus on “listening and learning” as an initial step. This focus raises concern that academic medical organizations will rely on racialized learners to teach others in the organization about racism through uncompensated efforts, burdening them with the responsibility of combatting institutional racism within the very organizations that actively marginalize them. 39 Student-led BLM movements have indeed been successful in driving institutional change in higher education. 40 However, it is unjust to place the onus of addressing systemic racism on medical learners given that they hold less power and ability to change the deeply hierarchical structures within academic medicine, while also having the most to lose professionally from potentially alienating faculty members who may influence their training and career progression. The burden of this work cannot fall solely on learners, but their voices must be centered and amplified. Institutions must commit resources to adequately support and maintain institutional antiracism efforts.

The absence of explicit support for the BLM movement in our archive may be surprising given that these public statements were issued directly in response to incidents of police brutality and global protests. Institutions may have avoided vocalizing support for BLM out of a fear of backlash given the politicization of the social movement by conservative media sources and the lack of support from white individuals. 26,41,42 Negative consequences for publicly supporting the BLM movement may include retaliation from stakeholders or donors, on whom institutions rely for financial support, and harm to the public reputation of the institution. While public support was high for the BLM movement in 2018, it skyrocketed in 2020. 43 Even for-profit corporations adopted “corporate political advocacy” strategies to prioritize social justice along with profit goals, even if social and political ideologies are known to alienate customers and stakeholders. 25 That more academic medical organizations did not voice support for the BLM movement in their statements may reflect organizational tactics of self-preservation, ideological norms of racial dominance, and the upholding of a problematic status quo. Further, institutions failing to affirm and support BLM in their statements suggest that physicians should be advocates for racial justice but remain apolitical. Perhaps most concerning, this discourse may inadvertently communicate that Black lives—Black patients’ lives—do not matter.

While medicine’s guiding doctrine of “first, do no harm” is similar in sentiment to the “to serve and protect” motto of law enforcement, academic medicine may not see itself as part of a system that perpetuates racial violence, like law enforcement. Given that racism manifests in medicine and law enforcement, racialized populations rightfully mistrust both systems. 44 In addition, police violence plays a significant role in shaping the health and well-being of society. Repeated police encounters increase mistrust in medicine across racial groups, as diminished trust in one profession positioned to serve and protect (i.e., law enforcement) spills into diminished trust in another profession positioned to do no harm (i.e., medicine). 44 This distrust in medicine is associated with lower health care utilization and adherence rates. 45–50 Police brutality also negatively impacts the mental health of Black people. 51 Many national organizations, including the AMA, now publicly acknowledge police brutality as a social determinant of health and a threat to public health. 52,53

Medical schools in the U.S. and Canada are mandated through the accreditation process to have social missions to address societal needs 54,55; yet addressing the historical legacy of anti-Black racism in medicine has heretofore been underemphasized by the vast majority of institutions. 56,57 In addition, this legacy of racism has created and preserved clinical and educational inequities, such as the exclusion of Black physicians from the AMA between 1895 and 1968, 2 the development of racist admissions policies, and the closure of HBCU medical schools following the publication of the Flexner Report in 1910. 1,58 If 5 of the 13 HBCU medical schools that were open in 1910 had not closed, an estimated additional 35,315 Black physicians would have been trained by 2019. 59 Evidence also affirms how structures and practices in academic medicine continue to discriminate against and disproportionately disadvantage Black trainees and physicians today. 3,4,6–9 This is a critical moment for academic medicine to urgently and adequately combat anti-Black racism through antiracist praxis, including reconceptualizing social accountability mandates and institutional equity, diversity, and inclusion efforts. 4,15,37,60 Without acknowledging the role that academic medical organizations play in perpetuating and addressing long-standing clinical disparities, these institutions will continue to uphold inequities and further perpetuate immense harm to Black learners, patients, and communities.

Limitations

Our findings are limited by the sample of initial statements included in our archive, as we did not analyze statements released by all medical schools in the U.S. Our archive also excluded any internal and subsequent communications (e.g., statements released after August 31, 2020), information surrounding the decision making or development of the statements, and any actions taken besides issuing the initial statements. While comprehensive in our analysis, other findings may be derived from research that includes additional statements and actions as well as other approaches to CDA. While many statements were signed by a senior faculty leader, we cannot confirm original authorship. In addition, we noticed that a number of schools in our initial search did not release statements during our study period, and an understanding of their decision to do so is beyond the scope of this study. For example, some institutions may have chosen to organize antiracism protests and enact rapid institutional responses rather than publish a statement. Future research is critical to understand the institutional responses that followed these statements and to fully understand the utility of these statements.

Conclusions

Academic medical organizations wield enormous power over the future of medicine and health care. Our analysis of a sample of the initial statements issued by academic medical organizations in Canada and the U.S. in response to the killing of George Floyd illuminates discursive conflicts and tensions that externalized and minimized the pervasiveness of anti-Black racism in academic medicine. While statements may have been well intentioned to signal solidarity, it is critical that institutions move beyond words to transformative action to abolish the deep-rooted institutional racism in academic medicine. Without a concrete commitment to ongoing and meaningful action to eliminate racist practices and policies, clear timelines for next steps, opportunities for community members to provide input and engagement, and accountability mechanisms, these initial institutional statements may be merely performative. In the end, actions will speak louder than words.

Acknowledgments:

The authors wish to thank Aya Ebdalla for her role in the early conceptualization and planning of this study as well as the Calgary Black Medical Students’ Association and the Black Medical Students Association of Canada for their tireless efforts in leading critical dialogue and institutional change over the last several years and, in particular, since May 25, 2020. The authors also wish to thank Kavya Anchuri and Rohan Khazanchi for their early feedback on this article.

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Appendix 1

AT1
Summary of Linguistic Inquiry and Word Count (LIWC) Results from a Critical Discourse Analysis of Statements Issued by Academic Medical Organizations After the Killing of George Floyd

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